The forgotten female: Pediatric and adolescent gynecological concerns and their reproductive consequences

Gynecologic Adnexal Tumors and Tumor-Like Lesions in Children and Adolescents: Experience at a Cancer Center

Introduction. Tumors and tumor-like lesions of the uterine adnexa in children and adolescents are uncommon but may carry devastating consequences. Methods. We conducted an observational retrospective cohort study, to describe patients aged 0 to 19 years diagnosed with tumors and tumor-like lesions of the uterine adnexa at our institution between 2000 and 2018. Results. Eighty-nine patients with 105 adnexal lesions were included. Thirty-seven (42%) patients presented with benign tumors, 13 (15%) with borderline tumors, 25 (28%) with malignant tumors and 14 (16%) with tumor-like lesions. Germ cell tumors (n = 45|43%) were the most frequent, followed by epithelial tumors (n = 30|29%). No significant differences were found in the age distribution of the lesions by malignant potential or histologic group. Most patients (n = 80|90%) were treated primarily with conservative surgery, including cystectomy (n = 25|28%) and unilateral oophorectomy/adnexectomy (n = 54|61%). Thirty-four (38%) underwent surgical staging (partial omentectomy and peritoneal biopsies). Twenty (23%) patients with borderline and malignant tumors were submitted to chemotherapy. Four (5%) patients with borderline or malignant tumors relapsed, one of whom died from disease. Conclusion. Gynecological lesions in children and adolescents encompass a wide range of rare histological tumor subtypes, requiring evaluation by experienced pathologists. Most tumors were diagnosed at early stages, with low relapse and mortality rates. Conservative management, with fertility sparing surgery and limited use of adjuvant chemotherapy, is of utmost importance.

Daily, weekly, seasonal and menstrual cycles in women's mood, behaviour and vital signs

Dimensions of human mood, behaviour and vital signs cycle over multiple timescales. However, it remains unclear which dimensions are most cyclical, and how daily, weekly, seasonal and menstrual cycles compare in magnitude. The menstrual cycle remains particularly understudied because, not being synchronized across the population, it will be averaged out unless menstrual cycles can be aligned before analysis. Here, we analyse 241 million observations from 3.3 million women across 109 countries, tracking 15 dimensions of mood, behaviour and vital signs using a women's health mobile app. Out of the daily, weekly, seasonal and menstrual cycles, the menstrual cycle had the greatest magnitude for most of the measured dimensions of mood, behaviour and vital signs. Mood, vital signs and sexual behaviour vary most substantially over the course of the menstrual cycle, while sleep and exercise behaviour remain more constant. Menstrual cycle effects are directionally consistent across countries.

Menstrual History-Taking at Annual Well Visits for Adolescent Girls

STUDY OBJECTIVE

To determine the rates at which primary care providers elicit menstrual histories from adolescent girls at well visits.

DESIGN

Retrospective chart review.

SETTING

The departments of Pediatrics, Adolescent Medicine, and Family Medicine of Cooper University Healthcare from January 1, 2010 to June 1, 2016.

PARTICIPANTS

Women aged 12-21 years who were seen for a well visit in the described setting.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

We searched physician well visit notes for documentation of the following aspects of menstrual history: menarche, last menstrual period, usual length of cycle, and the presence or absence of associated symptoms (such as pain and cramps). The presence or absence of each aspect was recorded in a binary fashion in a deidentified data set.

RESULTS

A total of 954 unique charts were analyzed: 415 from Adolescent Medicine, 289 from Family Medicine, and 250 from General Pediatrics at Cooper University Healthcare. Adolescent Medicine was 6.44 times more likely to take a complete menstrual history than Family Medicine (P < .0001) and 5.80 times more likely than Pediatrics (P < .0001). There was no statistical difference between Pediatrics and Family Medicine (odds ratio, 0.55; P = .3150).

CONCLUSION

Menstrual history-taking is often incomplete and can vary between departments, even within the same institution. These results indicate opportunities to raise awareness about the importance of a complete menstrual history and to develop quality improvement initiatives to increase documentation of the complete menstrual history.

Endometrial carcinoma in a single horn of a bicornuate uterus: A case report

We discuss the diagnosis and the management of endometrial carcinoma in a single horn of bicornuate uterus in a 64-year-old woman as a case report. The case underwent laparoscopic radical hysterectomy and bilateral iliac lymphadenectomy. The gross examination of the uterus revealed a bicornuate uterus with a greater horn of 12 × 9 × 8 cm and a smaller horn of 10 × 3 cm. The cavity of the greater horn showed a neoplastic growth of 10 cm with infiltration of about 1,8 cm of the myometrium from whole thickness of 1.9 cm. while the other horn was free of tumor tissue. The microscopic examination of the uterus revealed G2 endometrioid adenocarcinoma of the endometrium of the greater horn with infiltration of more than 50% of the myometrium. In the presence of bicornuate uterus, a bilateral endometrial biopsy should be performed in order to reduce the risk of delayed or missed diagnosis. The management of a case of bicornuate unicollis uterus with endometrial carcinoma in only one horn is the same as patients with endometrial cancer in single uterus and depends mainly on stage and histological grade of the tumor. The possibility of existence of a separate uterine cavity should always be considered when endometrial cancer is clinically suspected but pathology fails to confirm the diagnosis. This points out the importance of a careful physical examination and radiographic evaluation in such cases.

The Treatment of Dysmenorrhea

Menstrual disorders and abnormal uterine bleeding are common concerns of young women. Complaints include menses that are: too painful (dysmenorrhea), absent or occur irregularly (amenorrhea or oligoamenorrhea), or prolonged and heavy (menorrhagia, or excessive uterine bleeding). In providing optimal reproductive care, the medical provider must be able to distinguish between normal developmental patterns or symptoms requiring education and reassurance from pathologic conditions requiring prompt assessment and treatment. This article discusses the normal menstrual patterns seen in adolescent females and provides an evaluation and management approach to primary and secondary dysmenorrhea.

Endometrial carcinoma located in the right septate uterus cavity: a case report

Endometrial cancer in patients with uterine congenital malformations is exceptional and there are only a few rare cases published in the literature. We report the case of a 67 years-old patient with an endometrial cancer located in the right cavity of a complete septate uterus.

Endometrial adenocarcinoma in one horn of a didelphic uterus with vaginal duplication

A 59-year-old female patient presented with vaginal bleeding. A didelphic uterus with vaginal duplication was diagnosed on the basis of physical examination and radiology tests. Biopsy revealed an endometrial cancer in the left horn, while the right was atrophic. Laparoscopic hysterectomy, bilateral salphingo-oophorectomy, pelvic and para-aortic lymphadenectomy were performed. According to Federation International of Gynecology and Obstetrics (FIGO) staging the tumour was classified Ib. The adjuvant therapy was vaginal cuff brachytherapy. After 6 months, she has no evidence of the disease.

Consulta ginecológica sob a ótica de estudantes do ensino médio do Rio de Janeiro, RJ

OBJETIVO: Analisar diferenças socioculturais e percepções sobre a consulta ginecológica por adolescentes. MÉTODOS: Estudo transversal com 418 alunas do ensino médio de três escolas de diferentes perfis, localizadas na cidade do Rio de Janeiro, RJ, em 2010. Aplicou-se questionário estruturado, abordando características sociodemográficas, comportamento sexual e avaliação da consulta ginecológica. Utilizou-se o teste de Qui-quadrado (Yates) e o t de Student, adotando-se p < 0,05. RESULTADOS: Alunas dos colégios privado e público apresentaram perfis semelhantes e diferiram daquelas da rede pública estadual que tiveram nível socioeconômico mais baixo, menor escolaridade dos responsáveis, predominância da raça negra, maior número de parceiros, gestações e histórico de violência sexual. As médias de idades da menarca e sexarca foram semelhantes entre as estudantes e a primeira consulta ginecológica foi significativamente mais tardia nas alunas da rede estadual. A maioria referiu conhecimento sobre anticoncepção e doenças sexualmente transmissíveis, porém pequena parte obteve essas orientações na consulta. As estudantes manifestaram desejo de que o profissional investisse mais tempo, paciência e disponibilidade no atendimento. CONCLUSÕES: O atendimento ginecológico na adolescência é insatisfatório segundo a avaliação das adolescentes estudadas. As usuárias dos serviços privados submetem-se à consulta ginecológica em idade mais precoce do que aquelas que têm acesso apenas à rede pública. É necessário criar mecanismos que facilitem o acesso e a adesão desse grupo etário à rotina preventiva ginecológica.

Hospitalization in adolescence affects the likelihood of giving birth: a Swedish population-based register study

AIM

To examine the effect of hospitalization during adolescence on the likelihood of giving birth.

METHODS

142 998 women born in 1973-75 were followed with the help of the Swedish Medical Birth Register (MBR) and the Swedish Total Population Register (TPR) up until the end of 2000 with respect to their likelihood of giving birth. All analyses were adjusted for parental socio-economic characteristics and factors related to the studied women's own birth.

RESULTS

The likelihood of giving birth between 20 and 27 years of age was positively affected by hospitalization at least once during adolescence according to the Swedish Hospital Discharge Register (HDR); adjusted hazard ratio (HR) = 1.32, 95% confidence interval: 1.29-1.35. Women hospitalized due to genitourinary diseases, respiratory diseases, abdominal problems and abuse of alcohol and drugs were more likely to have given birth during the study period, while hospitalizations according to cerebral palsy and congenital malformations tended to decrease childbearing. Women hospitalized due to psychiatric diseases had an increase likelihood of given birth at 20-24 years but a reduced thereafter.

CONCLUSION

A majority of the causes of hospitalization during adolescence increased the likelihood of giving birth between ages 20 to 27.

Genitourinary assessment: an integral part of a complete physical examination

This article provides primary care providers, including pediatric nurse practitioners, with a framework for completing a genitourinary assessment. Many primary care providers are reluctant to examine the genitalia of their patients. Routine genital examinations increase diagnostic skills, provide a baseline for future examinations, may improve parent and child compliance with the examination, and may reveal previously undiscovered anomalies or trauma. An assessment of the reproductive and urologic systems should begin with obtaining a focused history from the parent from birth to present. Techniques for performing a focused genitourinary examination will be discussed.

Endometrial cancer arising in both horns of didelphys uterus in a Down's syndrome woman

BACKGROUND

There are only few reports of endometrial cancer arising in patients with uterine malformations. Down's syndrome is characterized by a reduced risk of solid tumors, and there are no reports about its correlation with uterine malformations.

CASE

An endometrial adenocarcinoma arising in both horns of a didelphys uterus of a Down's syndrome woman.

CONCLUSION

Uterine malformations and genetical disorders may cause a delayed diagnosis of gynecological cancers. Gynecological examination in asymptomatic patients and differential diagnosis in abnormal uterine bleeding patients should be considered.

Endometrial carcinoma in one horn of a bicornuate uterus

BACKGROUND

Tamoxifen therapy is related to endometrial adenocarcinoma. Bicornuate uteri are more common than assumed. There are a few reports of endometrioid carcinoma arising in a bicornuate uterus, but none of these discuss a serous papillary component or an association with tamoxifen therapy.

CASE

This is a case of a mixed endometrioid and serous papillary endometrial carcinoma arising in one horn of a bicornuate uterus. Multiple benign polyps were also present.

CONCLUSION

Adequate tissue sampling of both horns is critical to arriving at a timely and accurate diagnosis of malignancy in patients with a bicornuate uterus.